That Delicate Balance

In a UVM study, seniors stay stable through Tai Chi

The lights are off at the Vermont Kung Fu Academy in Essex Junction, creating a womblike darkness. Fierce-looking martial arts weapons rest unused against a wall. Janet Makaris, the soft-spoken Tai Chi instructor, leads her students through a series of relaxation exercises and movements. She invites them to envision their spines as stacks of checkers; to perform "tootsie rolls" with their feet; to imagine a moon floating in the silence of their minds.

Focusing on footwork, Makaris adjusts her own New Balance-clad feet on the carpeted floor and suggests, "Imagine you're surfing or skateboarding."

Nancy Tracy of Burlington, 73, has a more age-appropriate image in mind for finding her balance: "How about the ice in the parking lot this morning?"

Tracy's fear of falling is justified.

More than 33 percent of adults aged 65 and older take a tumble each year, according to the National Center for Injury Prevention and Control. Furthermore, recovering from a spill often isn't simply a matter of getting up again. The Centers for Disease Control report that fall-related injuries send millions to the hospital, and are fatal for thousands. As winter descends on Vermont, the snow and ice present additional hazards.

But a new study out of the University of Vermont has good news for the 65-plus crowd -- or anybody, for that matter, who's seeking balance and stability. The research examines how the ancient practice of Tai Chi can help people avoid hospital visits and reduce their fear of falling.

"As we age, we all know, we develop less muscle strength and function," says Ge Wu, an associate professor in UVM's Depart-ment of Physical Therapy. "My research interest was originally in understanding why, and how, our bodies function to maintain balance -- why, on a slippery patch, for instance, do some people fall and some people not fall?"

Wu's interest led her to examine how preventative exercises might improve balance. Strength training has long been touted as a great way to stay vertical. But, as Wu points out, this approach isn't always appealing to people who aren't in the habit of, say, performing bench presses. "Some people say, 'I've never lifted weights before; why should I start now?'" Wu says. "Or, 'My muscles are sore,' so there's no motivation; it's not fun."

Eventually, Wu turned to Tai Chi -- a daily discipline for people, especially elders, all over the Eastern Hemisphere; public parks there are packed with practitioners. "It's so popular in Asian countries, and we knew that it probably benefited balance," Wu says. "But the evidence was mostly anecdotal, of people saying that they felt better."

Wu emigrated from China 20 years ago. In 1999, she returned to participate in a study of Tai Chi at Beijing University of Physical Education. The research compared a group of seniors who had been practicing Tai Chi for two to 10 years with another group who had being doing other forms of exercise, such as aerobics. "We said, 'Wow, there really is a significant difference here,'" Wu says. "But when I came back, I found only a handful of articles about Tai Chi and balance.'"

From 2000 to 2001, Wu conducted a study in Vermont, examining how 12 weeks of Tai Chi might benefit members of the elderly community she found through the state's home-health network. "There was a significant reduction of fear of falling among people who had been falling," she says. "They had improved their strength and functions and were able to stand up, walk and come back in a shorter period of time; they were also standing on one leg."

Why is Tai Chi so good for balance? Instructor Janet Makaris looks on the spiritual side. "Chi is the prayer of life," she says. The centuries-old practice looks like slow-motion kung-fu fighting -- minus the opponent. Some have described it as a combination of yoga and meditation.

Wu worked up an outreach strategy that was perfectly suited to Americans. She found 17 local senior citizens who were willing to practice Tai Chi on television from February to May this year. Instead of meeting with Makaris in person, they turned on their tubes, which were equipped with videoconferencing technology. In a multimedia center at UVM, Wu plays a clip from one session, a split screen that shows the Tai Chi students in various living rooms and assisted-living facilities. Some use walkers; others are with companions who seem content to sit in an easy chair while the Tai Chi takes place. From her UVM studio, Makaris can see and talk to the students. "Step over the cat food can, do a baby curtsy," she says, using her signature imagery to describe the movements. "You look nice. That was very, very nice," she adds before giving the class a break.

"It was a huge success," says Wu, before fast-forwarding the video clip. Although there were several subzero days, snowstorms and school cancellations while the study was in progress, classes went on as usual. Once again, the Tai Chi resulted in better balance among the students, many of whom now travel to the Vermont Kung Fu Academy to continue their work with Makaris.

But Wu wanted quantifiable evidence of Tai Chi's benefits. So she took her research one step further, examining the mechanics of the movement through electromyographic electrodes, a force platform and motion-analysis cameras at UVM's motion-control laboratory. Using tiny, electric nodules placed at strategic points on the body, studying computerized images of movement and measuring forces, Wu was now able to measure what had been anecdotal evidence.

Wu and her research colleagues discovered that Tai Chi targets muscles that aren't exercised through walking -- muscles such as the dorsiflexors and knee extensors, which help prevent falls. "The other thing we found from the motion control was co-activation, or using both sides of the muscle," says Wu. "It's a whole different motor-control strategy in the central nervous system that as we age, we probably forget, and co-activation provides stability in the joints." A third finding was that Tai Chi activates "eccentric" strength -- the sort of fast-twitch muscle fibers that sprinters use.

"It was all positive," says Wu. She's now working on a proposal for Phase 2 of "Tele Tai Chi," and on future studies related to the relationship between Tai Chi and cardiovascular health and arthritis. Wu expects that future findings will also corroborate the emotional boost her study participants received from Tai Chi: subjects rated themselves 18 percent less afraid of falling on a post-session survey.

That added peace of mind may be motivation enough for students like Nancy Tracy to keep moving through Makaris' imagery. After back surgery two years ago, she was told she would never walk again. After physical therapy, she is back on her feet. While Tracy says she's still seeking a strong feeling of stability, she's able to conquer the elements that will send many of us sprawling this winter. "We were joking about walking on black ice in class," says Tracy. "But I really did last Friday, and I stayed up! I was doing a little dance and I stayed up."

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